Just how ill do you have to be to qualify for long-term care help?

More and more of the long-term sick are being denied free medical care.

Shirley Yeoman requires round-the-clock care. The grandmother of five is unable to move unaided, has problems swallowing and cannot survive without the care of nurses. Over the past 20 years she has had a brain tumour, a stroke, an aneurysm and now has fortnightly epileptic fits.

Yet according to her local primary care trust, Mrs Yeoman is not ill enough to qualify for free continuing NHS care. Rather than a "primary health need" – which would result in free continuing, or long-term care – she is categorised as having a "social need", and her family has to pay the lion's share of her care bills.

Mrs Yeoman's husband Geoff fails to see why his wife does not qualify for free long-term care, as she has been in receipt of it in the past.

In 2008 after a period in intensive care, Mrs Yeoman was discharged and granted free nursing care in her own home – under the terms of continuing health care. Continuing care patients are regularly reassessed, and during one of these assessments, despite no improvements to her case, Mrs Yeoman was deemed no longer eligible.

Mr Yeoman was given just 24 hours to find alternative arrangements. Then, after three years of caring for his wife himself at home, constantly battling for continuing care funding, Mr Yeoman himself was diagnosed with a brain tumour.

Because of his own health problems, Mr Yeoman is no longer able to care for his wife. Mrs Yeoman is now in a nursing home, where only part of the fees are covered by social-care funding.

Mr Yeoman said: "I am not a rich man. She seems to be happy and everyone is very helpful, but Shirley needs continuing care. Everyone was very surprised when she did not qualify – the GP and the nurses have been excellent, but they agreed too: she has a primary care need."

Unfortunately, the local primary care trust Suffolk PCT, does not agree. Anne Reed, of Paladin Advocates, a law firm that specialises in helping families secure continuing care, said: "In other Primary Care Trusts we believe that she would have qualified. I am dismayed by the lack of compassion shown by Suffolk PCT to consider Mrs Yeoman's case on its individual circumstances and in particular, in light of the gravity of Mr Yeoman's health at the time of Mrs Yeoman's assessment."

Unfortunately, this case is not an anomaly. On the NHS Continuing Care files there are numerous examples of families who are trapped in a similar situation. Many cases refer to Alzheimer's, incontinence and immobility – but still patients do not seem to be getting the help they need.

Ms Reed has called for changes in the system. She said that families and patients should be treated with empathy and compassion in the continuing-care assessment process, and said there needs to be consistent application of the national framework and legislation across NHS organisations.

"I deal with PCTs from Newcastle, Cornwall, Suffolk and Wirral – no one area seems any better than anywhere else," said Ms Reed. "The NHS Act of 1947 stipulated that it would provide care from the cradle to the grave, and that just doesn't seem to be the case."

First Stop Care Advice, a free service for elderly people, said the recent Dilnot Commission had failed to suggest a viable solution to the biggest flaw in the social care system – underfunding.

A spokesman said: "One of the big issues at the moment is that, because the social care system is underfunded, councils are only helping people with critical needs, and those with low or moderate care needs are either having to fully fund themselves from savings or equity release, rely on family and friends or do without."

He added that this was a "false economy", because this lack of care is likely to mean more older people will need more intensive (and costly) care at a latter stage.

A spokesman for NHS Suffolk said it could not comment on an individual case, which is currently progressing through the appeals process. £A care assessment is carried out by your local primary care trust. This determines whether you qualify for help with care funding – called NHS nursing care contribution – or whether you can receive full funding, called NHS continuing care. To be eligible for continuing care you must be deemed to have a "primary health need".

The difficulty lies in determining the threshold between the two. Many people are incorrectly categorised or their health diminishes, making the original assessment invalid.

Before October 2007, each care trust set its own criteria for eligibility for continuing care. In some parts of the country, many elderly people were receiving free care, while in others hardly any were enitled. The Health Service Ombudsman set national guidance for care trusts to follow from October 2007 and it was assumed that this would mean the end of the postcode lottery. Unfortunately, this has not been the case.

Assessment is done in two parts. The first stage is based on an individual's needs in accordance with the national framework for continuing health care. A checklist identifies people who are probable candidates for free continuing care, and they are then assessed in stage two.

Stage-two decisions are based on 11 "care domains", including behaviour, cognition, mobility, continence, breathing and medication. An assessor then confirms or dismisses a person's eligibility for free care.

Those not deemed eligible may be entitled to aid from a registered nurse and the NHS nursing care contribution, which is a non-means-tested weekly payment paid to a nursing home towards nursing fees. Patients will still need to pay for their accommodation, board and personal care.

To complicate the issue, this contribution is different for residents of England, Northern Ireland, Scotland and Wales. Residents of England are entitled to £108.70 a week, in Northern Ireland it's £100 a week and in Wales £120.55 a week. Scottish residents may receive £159 a week towards personal care and £72 a week for nursing care.

The Telegraph is hosting a free seminar providing expert financial advice on how to pay for long term care. To reserve a place call 0845 600 4622 or reserve a place online.